×

Quiz Session - Attempts With Random Questions

ANCC AGPCNP-BC Exam Questions

Page 8 of 25

141.

In the patient with atrial fibrillation (AF), what is the target goal of the patient's INR levels?

  • 2.0 to 3.0

  • 0.9 to 1.1

  • 1.5 to 2.0

  • 2.5 to 3.5

Correct answer: 2.0 to 3.0

AF is the most common cardiac arrhythmia in the United States. It is a major cause of stroke and is classified as a supraventricular tachyarrhythmia. AF may be asymptomatic. Warfarin for anticoagulation remains the most prescribed therapy for patients with AF. The full effect of the warfarin generally takes 2 to 3 days. Therefore, INR levels should be checked every 2 to 3 days until therapeutic for two consecutive checks; then weekly rechecks and so on until INR is stable at 2.0 to 3.0. Once stable, INR levels should be checked every four weeks.

142.

Bupropion (Zyban, Wellbutrin SR) is indicated for all of the following conditions except:

  • Anorexia/bulimia

  • Major depression

  • Seasonal affective disorder (SAD)

  • Smoking cessation

Correct answer: Anorexia/bulimia

Bupropion is an atypical antidepressant that treats major depression, seasonal affective disorder, and smoking. It increases the seizure threshold and thus is contraindicated with seizure disorders. It is also contraindicated in anorexic/bulimic patients.

143.

What is the medication of choice for a patient with a diagnosis of mononucleosis?

  • Penicillin VK

  • Amoxicillin

  • Erythromycin

  • Dicloxacillin

Correct answer: Penicillin VK 

Penicillin VK is the medication of choice for patients with mononucleosis. If there is a penicillin allergy, use a macrolide antibiotic, such as erythromycin. Avoid using amoxicillin because it causes a generalized rash not related to an allergic reaction. Dicloxacillin is not indicated for use with mononucleosis.

144.

The adult gerontology nurse practitioner knows that the patient on digoxin therapy requires careful monitoring of vision due to adverse effects. All of the following adverse effects can occur except:

  • Mydriasis

  • Blurred vision

  • Yellow to green vision

  • Halos if blood level is too high

Correct answer: Mydriasis

In the patient on digoxin therapy, adverse effects include yellow to green vision, blurred vision, and halos if the blood level gets too high. Check that the patient has a baseline eye exam with regular eye exams performed by an ophthalmologist to ensure adverse effects do not occur.

Mydriasis, or dilation of the pupil, may be seen with Topamax therapy.

145.

When performing a physical exam, the nurse practitioner assesses the cardiovascular system for both innocent and abnormal heart murmurs. Using the grading system for heart murmurs, at which grade is the first time that a thrill is present and can be palpated?

  • Grade IV

  • Grade II

  • Grade III

  • Grade V

Correct answer: Grade IV

Heart murmurs are graded using a system from grade I (very faint murmur only heard under optimal conditions) to grade VI (a murmur that is so loud that it can be heard even when the stethoscope is off the chest). A grade V heart murmur is also a louder murmur, and grade IV is the first time a thrill is present. A thrill is like a "palpable murmur" because the examiner can feel a fine vibration by placing their hand over the location of the patient's murmur. The thrill is the result of turmoil in the flow of blood.

146.

Which of the following is the correct normal laboratory value for mean corpuscular volume (MCV)?

  • 80-100 fL

  • 31-37 fL

  • 25-35 fL

  • 14-18 fL

Correct answer: 80-100 fL 

MCV is the measure of the average size (or volume) of RBCs in a sample of blood. A high MCV (> 100 fL) indicates that a person's RBCs have a larger average size than normal, and is called macrocytosis. A low MCV (< 80 fL) indicates microcytosis.

147.

All of the following are true of the "sundowning" phenomenon except:

  • Patients should avoid well-lit rooms

  • This phenomenon occurs in both dementia and delirium

  • Symptoms resolve in the morning

  • Patients should avoid drugs that affect cognition

Correct answer: Patients should avoid well-lit rooms

The "sundowning" phenomenon is a ubiquitous and startling pattern of disruptive behavior in both delirium and early dementia patients that occurs in the early evening (starting at dusk/sundown) that impacts the patient's quality of life. The patient often becomes agitated, confused, and combative. Symptoms often resolve in the morning. This phenomenon is seen more with early dementia and recurs commonly. 

Treatment involves avoiding quiet and dark rooms, and instead, having well-lit rooms with a radio, TV, or clock present. Familiar surroundings are important, and the patient should avoid drugs that affect cognition (sedatives, antihistamines, hypnotics, narcotics).

148.

Of the following selective serotonin reuptake inhibitors (SSRIs), which has the shortest half-life?

  • Paroxetine (Paxil)

  • Fluoxetine (Prozac)

  • Citalopram (Celexa)

  • Sertraline (Zoloft)

Correct answer: Paroxetine (Paxil) 

Paxil has the shortest half-life of any SSRI, which may increase the risk of withdrawal reactions with this drug. Tapering the drug rather than abrupt discontinuation should minimize such a reaction. 

Prozac has the longest half-life of all SSRIs; Celexa has fewer drug interactions compared with other SSRIs.

149.

The U.S. Preventative Services Task Force (USPSTF) recommends screening for lung cancer in all of the following patients except:

  • A 64-year-old male with a 30-pack-year history of smoking who reports he quit 16 years ago

  • A 55-year-old female patient with a 30-pack-year history of smoking and currently smokes

  • A 75-year old male with a 30-pack-year smoking history who quit ten years ago

  • A 75-year-old male with a history of smoking who currently smokes

Correct answer: A 64-year-old male with a 30-pack-year history of smoking who reports he quit 16 years ago

According to the USPSTF, lung cancer screening includes:

  • Screening for persons who smoke (30 pack-years) or have quit in the past 15 years
  • Age 55 to 80 years: Annual screening with low-dose computed tomography (LDCT)
  • Discontinue screening once a person has not smoked for 15 years or develops a health problem that substantially limits life expectancy or the ability or willingness to have curative lung surgery

 Thus, screening is not recommended in the patient who quit over 15 years ago.

150.

What is the antibiotic of choice for human, dog, and cat bites?

  • Augmentin

  • Doxycycline 

  • Bactrim 

  • Clindamycin 

Correct answer: Augmentin

Antibiotic prophylaxis should be considered, especially if there is a high risk of infection, such as with cat bites, puncture wounds, wounds to the hand, and in persons who are immunosuppressed. Amoxicillin and clavulanate (Augmentin) is a drug combination that extends the antibiotic spectrum of penicillin to include bacteria normally resistant to beta-lactam antibiotics. Amoxicillin and clavulanate is first-line therapy for the prophylactic treatment of dog, human, and cat bites. 

151.

An elderly patient presents with a low-grade fever with chills, mild cough, weakness, and confusion. What should the nurse practitioner suspect as a likely diagnosis for this patient?

  • Pneumonia

  • Pleurisy

  • Severe dehydration

  • Influenza

Correct answer: Pneumonia 

The classic presentation of pneumonia is sudden onset of a high fever (100.4 or higher) with chills, a productive cough with purulent sputum, pleuritic chest pain, and dyspnea. However, elderly patients may have atypical symptoms (afebrile or low-grade fever, no cough or mild cough, weakness, altered mental states) before showing more common symptoms.

152.

The acronym "ACHES" outlines danger signs of oral contraceptive use. What does the 'H' stand for in this acronym?

  • Headaches

  • Heart palpitations

  • Hypertension

  • Hematuria

Correct answer: Headaches 

Thromboembolic events can happen in any organ of the body. The symptoms referenced by the acronym may indicate a thromboembolic event. Advise patients to report these or to call 911 if symptoms of ACHES occur, which include:

  • A: Abdominal pain
  • C: Chest pain
  • H: Headaches
  • E: Eye problems; change in vision
  • S: Severe leg pain

153.

All of the following are risk factors for prostate cancer except:

  • Immunosuppression and smoking

  • Age 50 years or above

  • African ancestry

  • First-degree relative with prostate cancer

Correct answer: Immunosuppression and smoking 

 The following factors may increase the risk of developing prostate cancer:

  • Age: The risk of prostate cancer increases with age, especially after age 50. More than 80% of prostate cancers are diagnosed in men who are 65 or older.
  • Race/ethnicity: Black men have a higher risk of prostate cancer than white men; they are also more likely to develop prostate cancer at an earlier age and to have more aggressive tumors that grow quickly. The exact reasons for these differences are not known and may involve genetic, socioeconomic, or other factors. Hispanic men have a lower risk of developing prostate cancer and dying from the disease than non-Hispanic white men.
  • Family history: Familial prostate cancer occurs about 20% of the time. If a man has a first-degree relative (i.e., father, brother, or son) with prostate cancer, his risk of developing prostate cancer is two to three times higher than the average risk. This risk increases even further with the number of relatives diagnosed with prostate cancer.

Immunosuppression and smoking are risk factors related to the development of cervical cancer. 

154.

Which of the following statements made by the patient with chronic kidney disease (CKD) indicates a need for further teaching of the renal diet?

  • "I need to increase my intake of foods high in potassium, such as potatoes, avocados, spinach, bananas, apricots, and sports drinks."

  • "It's important that I keep track of my fluid intake and limit the amount of fluids I'm drinking each day."

  • "I should keep my sodium intake at 400 mg per meal and 150 mg per snack."

  • "I need to limit my intake of phosphorus-rich foods like dairy, meats, canned fish, nuts, and beans."

Correct answer: "I need to increase my intake of foods high in potassium, such as potatoes, avocados, spinach, bananas, apricots, and sports drinks."

A renal diet is indicated for CKD and acute renal failure. This diet limits protein, phosphorous, sodium, and potassium. Fluids may also need to be limited, and the patient should keep track of all fluids consumed, including jello, popsicles, etc. This diet can help slow down the rate of damage to the kidneys. The patient should decrease their intake of high-potassium foods, not increase it.

155.

The nurse practitioner is performing a physical exam on an adult female patient who complains of dysuria and flank pain on the left side. Which ethical concept is this NP exhibiting?

  • Beneficence

  • Justice

  • Accountability

  • Veracity

Correct answer: Beneficence 

Beneficence is defined as an obligation to help a patient by removing harm, preventing harm, and promoting good. In this scenario, the NP is acting in the patient's best interest, providing compassionate patient care and advocating for the patient by examining her in order to diagnose her condition properly. 

Justice is the quality of being fair and acting with a lack of bias. Accountability is the obligation to take responsibility for one's own actions and their consequences, rather than blaming others for mistakes. Veracity is simply the obligation to present information in an honest and truthful way. 

156.

What is the gold-standard test to diagnose any anemia involving abnormal hemoglobin?

  • Hemoglobin electrophoresis

  • Serum ferritin and serum iron levels

  • Complete blood count (CBC)

  • Reticulocyte count

Correct answer: Hemoglobin electrophoresis 

Anemia occurs when a person's hemoglobin drops below normal. Hemoglobin electrophoresis is used to measure and identify the different types of hemoglobin in the bloodstream. However, before ordering this test, iron-deficiency anemia, the most common in the world for all ages/races/gender, must be ruled out.

Anemia may first be detected with a CBC, a test that counts the number and relative proportion of each of the different types of cells in the bloodstream. An elevated RDW is one of the earliest indicators of iron-deficiency anemia, which can be seen in the CBC. Reticulocyte count can also be determined by a CBC. If iron-deficient anemia is suspected (elevated RDW), serum ferritin and serum iron levels are drawn. Once ruled out, hemoglobin electrophoresis should be performed to diagnose any other anemia (sickle cell, alpha or beta thalassemia, etc.).

157.

Based on the following patient variables, which patient should the provider assess for suicide risk?

  • A recently widowed 70-year-old 

  • A 12-year-old having academic struggles

  • A patient who assesses at 5 points on the GAD 7 scale

  • A patient with a positive AUDIT score

Correct answer: A recently widowed 70-year-old 

Of the variables presented, the patient who is 70 years old falls into the category of being at a high risk for suicide. Elderly persons who experience the loss of a spouse through death or divorce are at high risk.

The 12-year-old does not match the criteria for suicide risk factors, and the risk factors are more commonly seen in individuals aged 15-24 years and over 60 years of age. The GAD 7 scale is a tool used to assess anxiety, not suicide risk. The AUDIT (Alcohol Use Disorders Identification Test) is a 10-question tool used for alcohol screening.

158.

A patient is seen in the primary care setting for complaints of a rash over the torso, upper back, and upper arms. The patient reports the rash developed quickly and that it has been bothering him for several days. Upon examination, the nurse practitioner observes multiple bright-red and pruritic lesions that have evolved into vesicular lesions. The rash appears to be asymmetrically distributed over the upper back and upper arms but follows a pattern on the torso. Some of the lesions have ruptured, leaving bright-red moist areas that the patient reports being painful, with a burning and stinging sensation. Other lesions have crusted over and become lichenified as a result of chronic scratching. 

All of the following are appropriate interventions in the management of this condition except:

  • Prescribe azole antifungal cream BID x 2 weeks

  • Prescribe topical steroids such as triamcinolone cream to apply QD or BID for 1 to 2 weeks

  • Instruct patient to take oatmeal baths (Aveeno) as needed

  • Instruct the patient to use calamine lotion as needed

Correct answer: Prescribe azole antifungal cream BID x 2 weeks 

With a diagnosis of contact dermatitis, management involves:

  • Stop exposure to substance
  • Topical steroids applied once to twice a day x 1 to 2 weeks. With lichenified skin, use high-potency steroid (triamcinolone, Halog), calamine lotion, oatmeal baths PRN
  • Consider referral to allergist for patch testing

Azole antifungals (ketoconazole, terbinafine) would be indicated for a diagnosis of tinea versicolor, a superficial skin infection caused by yeasts.

159.

Which information would be a contraindication for the nurse practitioner to advise an 18-year-old female regarding receiving the varicella vaccine?

  • Avoid getting pregnant within four weeks of receiving the booster 

  • A low-grade fever is possible within 24 to 48 hours after injection

  • Soreness may occur at the injection site 24 to 48 hours after injection

  • Redness at the injection site may be present 24 to 48 hours after injection

Correct answer: Avoid getting pregnant within four weeks of receiving the booster

The varicella vaccine should not be administered to pregnant women, as it is contraindicated during pregnancy. Women should be counseled to avoid becoming pregnant for four weeks following the vaccine administration as it is a live virus and can present risks to a fetus.

The other answer choices are not considered contraindications, and are possible side effects that may occur as a result of the injection.  

160.

Which step in the research process includes a final report and publication of findings?

  • Dissemination

  • Analysis

  • Implementation

  • Conception

Correct answer: Dissemination

The research process consists of five generalized phases. The phase where reports and publication of findings occur is phase V, dissemination. 

Phase I is conception, phase II is design and planning, phase III is implementation, and phase IV is analysis.

×